CHF

Question 1

CHF is insufficient ____ _____ associated with increased blood volume and edema

Answer 1

cardiac output

Question 2

This class reduces congestive symptoms

Answer 2

diuretics

Question 3

This class reduces preload and ventricular wall stress (benefit) but can increase RAAS activation

Answer 3

diuretics

Question 4

_____ therapy should be accompanied by dietary salt restriction and lowest dose needed

Answer 4

diuretic

Question 5

This class shows no reduction in mortality except aldosterone antagonists

Answer 5

diuretics

Question 6

____ diuretics work when GFR is low

Answer 6

loop

Question 7

_____ diuretics are ineffective when GFR is low

Answer 7

thiazides

Question 8

Major problem with loop diuretics is _____ depletion

Answer 8

K

Question 9

Diuretic resistance is often seen as CHF progresses due to issues of compliance, _____ in Na+ reabsorption, and decreased _____ perfusion

Answer 9

compensation

renal

Question 10

______ diuretics are used primarily to potentiate the action of loops

Answer 10

thiazide

Question 11

can produce even greater K+ depletion

Answer 11

thiazide

Question 12

Aldosterone antagonists (K+ sparing) inhibit ______ and thus reduce _____

Answer 12

remodeling

mortality

Question 13

aldosterone antagonists can cause ______ (‘lyte abnormality)

Answer 13

hyperkalemia

Question 14

_____ inhibitors decrease production of Ang2, aldosterone and SNS activity

Answer 14

ACE

Question 15

Ang2 levels move toward _____ with sustained use of _____

Answer 15

baseline

ACEI’s

Question 16

clinical efficacy is maintained after prolonged use of ACEIs probably due to _____ related effects

Answer 16

bradykinin

Question 17

High doses of _____ reduce mortality

Answer 17

ACEIs

Question 18

_____ block AT1 but not AT2 receptors

Answer 18

ARBs

Question 19

Maintain beneficial Ang2 effects and avoids Ang2 escape seen with ACEIs

Answer 19

ARBs

Question 20

Alternative for patients intolerant of ACEIs (cough)

Answer 20

ARBs

Question 21

T or F: ARBs reduce mortality

Answer 21

true

Question 22

_____ mainly reduce preload and tolerance is an issue when used alone

Answer 22

nitrates

Question 23

____ reduces pulmonary and systemic vascular resistance (afterload)

Answer 23

hydralazine

Question 24

____ has a moderate direct positive inotropic effect

Answer 24

hydralazine

Question 25

Fixed-dose combo of ______ and _______ reduces mortality especially in African-Americans

Answer 25

isosorbide | hydralazine

Question 26

These drugs counterintuitively decrease mortality because they reduce contractile force

Answer 26

beta blockers

Question 27

_____ _____ prevent cardiac ischemia and consequently unstable tachyarrhythmias

Answer 27

beta blockers

Question 28

these drugs inhibit cardiac remodeling and *reduce renin secretion*

Answer 28

beta blockers

Question 29

these reduce cardiac remodeling

Answer 29

ACEIs ARBS beta blockers

Question 30

ACEI result in elevated bradykinins which can be good and bad - good things include _____ and decreased _____ while bad thing(s) are _____

Answer 30

vasodilation remodeling cough

Question 31

Cardioselective beta blockers

Answer 31

metoprolol bisoprolol carvedilol

Question 32

the primary pharmacological effect of ____ is to have a (+) inotropic effect

Answer 32

digoxin

Question 33

Use of ____ in CHF therapy is controversial due to toxicity, *does not reduce mortality* and may *decrease survival in women*

Answer 33

digoxin

Question 34

decreases hospitalization in advanced CHF

Answer 34

digoxin

Question 35

Inhibits Na/K-ATPase in myocyte membranes

Answer 35

digoxin

Question 36

Hyperkalemia will ____ the inotropic effect of digoxin

Answer 36

reduce

Question 37

Hypokalemia will ____ the inotropic effect of digoxin

Answer 37

increase

Question 38

_____ will result in an *increased digoxin binding and thus increased inhibition of ATPase*

Answer 38

hypokalemia

Question 39

____ will result in a decreased digoxin binding to the ATPase

Answer 39

hyperkalemia

Question 40

hypokalemia promotes ____ overload

Answer 40

calcium

Question 41

can produce sinus bradycardia at low therapeutic doses

Answer 41

digoxin

Question 42

decreases conduction velocity and prolongs effective refractory period

Answer 42

digoxin

Question 43

causes calcium overload at toxic levels

Answer 43

digoxin

Question 44

excreted unchanged by the kidney

Answer 44

digoxin

Question 45

does not reduce mortality and may actually *increase in females*

Answer 45

digoxin

Question 46

Digoxin _____ ____ is used after an overdose and is an immune complex that sequesters digoxin

Answer 46

immune FAB

Question 47

Fatigue and yellow/green halos around objects typically indicate toxicity before cardiac signs appear when using ____

Answer 47

digoxin

Question 48

____ and ____ increase potassium and decrease digoxin efficacy

Answer 48

ACEIs | ARBs

Question 49

Drugs that reduce mortality in CHF (4)

Answer 49

isosorbide-hydralazine ACEIs/ARBs Aldosterone antagonists beta blockers

Question 50

drugs that only relieve symptoms

Answer 50

diuretics (loop/thiazide) | digoxin

Question 51

which 2 antiarrhythmics can increase plasma digoxin levels

Answer 51

quinidine | verapamil

Question 52

most common warning sign preceding digoxin toxicity

Answer 52

nausea/vomiting | anorexia